Module 13: Anemia (e)

Question 1

Iron Deficiency Anemia

-Info

Answer 1

1. Most common type — Occurs when iron loss exceeds iron intake & stores become depleted
   - Mircocytic, hypochromic
2. Most common causes
   - Blood loss
   - Occult malignancy
   - ASA
   - Poor iron absorption & impaired RBC production

Question 2

Iron Deficiency Anemia

-Treatment?

Answer 2

1. Ferrous Sulfate — Only contains 20% elemental iron
   —5 mg ferrous sulfate = 1 mg elemental iron
2. Dosing is weight based

A/E’s
-N/V/D, Constipation, Dark stools

Pt Education

• Take on empty stomach
• 3 times daily is best
• Vitamin C helps increase absorption
• May require stool softener

Monitoring

• Hgb, Hct, ferritin 4 weeks
• Reticulocytes count if severe — check in 5-10 days

Question 3

Iron Deficiency Anemia

-Pharm Treatment

Answer 3

1. Ferrous Sulfate — Only contains 20% elemental iron
   —5 mg ferrous sulfate = 1 mg elemental iron
2. Dosing is weight based

A/E’s
-N/V/D, Constipation, Dark stools

Pt Education

• Take on empty stomach
• 3 times daily is best
• Vitamin C helps increase absorption
• May require stool softener

Monitoring

• Hgb, Hct, ferritin 4 weeks
• Reticulocytes count if severe — check in 5-10 days Iron Deficiency Anemia

Question 4

Iron Deficiency Anemia

-Non-Pharm

Answer 4

1. Diet rich in foods containing iron
   - Organ meats (liver)
   - Red meat
   - Beans
   - Green leafy veggies
   - WHole grains

Question 5

Folic Acid Deficiency

-Info

Answer 5

1. High Risk Groups
   - Alcoholics
   - Vegetarians/Vegans
   - Infants fed powdered or goat’s milk
   - Pregnant women - increasing requirements
   - Celiac disease, Crohn’s, giárdia, short bowel syndrome
   - Phenytoin, carbamazepine, methotrexate**, Trimethoprim
2. Prevention
   - Adequate dietary intake
   - Supplementation in pregnancy

Question 6

Folic Acid Deficiency

-Treatment/Monitoring

Answer 6

1. Oral folic acid 1-2 mg/day 4-5 weeks
2. Monitor
   - Hgb levels begin to rise w/in one week
   - H&H at regular intervals - can monitor after 2 wks then monthly until stable

Question 7

Pernicious Anemia

-Info

Answer 7

1. Vitamin B12 deficiency that is autoimmune or linked to heredity
2. Other causes
   - Vegetarian/vegan (pregnant women)
   - Crohn’s
   - Gastric Bypass
3. Prevention
   - Adequate dietary intake (breakfast cereal**TEST)
   - Diet - Mollusks (clams) fortified cereals, liver, salmon, milk, eggs

Question 8

Pernicious Anemia

-Treatment

Answer 8

1. Nutritional deficit — 1000 mcg/day cobalamin until B12 levels normalize
2. Pernicious anemia — 1000 mcg IM daily for 1 wk followed by 1000 mcg IM weekly for a month
3. Monitoring
   - Reticulocytes, H&H, B12 monitored before therapy, after 7 days and at regular intervals
   - Potassium, LFTs

Question 9

Anemia of Chronic Disease

-Info

Answer 9

1. Most common form of anemia in older adults
2. Normocytic, normochromic (80%)
3. Macrocytic, normochromic (20%)

Causes

• Osteomyelitis, TB, Rheumatoid dz, hepatitis, carcinoma, myeloma, lymphoma, leukemia
• Renal failure — secondary to erythropoietin deficiency
• Endocrine disorders — reduce bone marrow responsiveness

TREAT UNDERLINING CAUSE **

Question 10

Thalassemia

-Info

Answer 10

1. Inherited blood disorders characterized by too little hemoglobin
   - Mediterranean, middle eastern, and south Asian populations
2. Two types
   - Alpha thalassemia
   - Beta Thalassemia (often misdiagnosed as Iron-deficiency anemia
3. Macrocytic, hypochromic
4. These people have TOO much Iron in their bodies — DO NOT give iron supplement

Question 11

Thalassemia

-Treatment

Answer 11

1. Alpha Thalassemia
   - Usually NO therapy
   - Low iron diet
   - Iron chelation therapy for iron overload
2. Beta Thalassemia
   - Avoid iron supplements
   - Severe — BLOOD Transfusion